Cardiac manifestations of pediatric COVID-19 and multisystem inflammatory syndrome in children

Background Cardiac problems may occur in children who have acute COVID-19 but are more prevalent with multisystem inflammatory syndrome in children (MIS-C). Aim of review The purpose of this article is to review the cardiac manifestations of COVID-19 in children and MIS-C, including evaluation and treatment. Key scientific concepts of review Myocarditis in children who have COVID-19 may occur from a combination of direct viral injury and immune-mediated cardiac tissue damage . Treatment of myocarditis in children includes supportive therapy, intravenous immunoglobulin, corticosteroids, and other immunomodulatory medications. Pericarditis may occur in 4.5 % of children with acute COVID-19 and 12 % to 25 % with MIS-C; treatment may vary with severity of pericarditis and may include pharmacotherapy with high-dose ibuprofen , colchicine , and anakinra , pericardiocentesis , and pericardiectomy . Ventricular dysfunction primarily involves the left ventricle and is observed in patients who have MIS-C but typically not acute COVID-19; treatment may include intravenous immunoglobulin and corticosteroids, but some patients may have deterioration and develop cardiogenic shock . Coronary artery abnormalities, including dilation and aneurysm, may occur in 0.9 % of patients who have severe acute COVID-19 and 13 % to 24 % of patients who have MIS-C; treatment may include prophylactic anticoagulation , especially in children aged >12 years. Arrhythmias occur in children who have severe cases of COVID-19 and 7 % to 60 % of children who have MIS-C and may include atrial tachycardia , atrial fibrillation , complete atrioventricular block , and ventricular tachycardia . Cardiovascular complications associated with COVID-19 may be difficult to diagnose in children. Longitudinal studies about the cardiovascular effects of COVID-19 in children may help identify patients who may have the highest risk of morbidity and mortality.